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Chronic Obstructive disease : 

Chronic Obstructive disease Thelma Monterroso, RN, BSN Image retrieved from

Objectives : 

Objectives Discussed the anatomy of respiratory system Define and discuss types of chronic obstructive disease Identify the etiologies of chronic obstructive pulmonary disease. Describe its pathophysiology Identify and discuss assessment criteria used in the care of the patient with chronic obstructive pulmonary disease. Understand the care and management of patient with chronic obstructive disease. Discuss health promotion and prevention

Anatomy of the lung : 

Anatomy of the lung Respiratory function Image retrieved from Alveoli Image retrieved from

Definition of COPD : 

Definition of COPD Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that are characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases (Kluwer, 2008). Picture retrieved from

Facts of COPD : 

Facts of COPD Major cause of death and disability U.S.A 4th leading cause of death in men U.S.A 5th leading cause of death in women U.S.A Mortality rates in women have increased by 53% and are still rising (American Lung Association, 2009) Picture retrieved from

Risk Factors : 

Risk Factors Smoking is the most common cause of COPD, accounting for 80-90 percent of all deaths. occupational hazards air pollution Second-hand smoke. Other causes of COPD include a history of childhood respiratory infections and heredity. Researchers are identifying certain genetic traits (American Lung Association, 2009) Picture retrieved from

Types of COPD : 

Types of COPD Chronic bronchitis Chronic infection or irritation of the bronchi. The mucus glands of the tracheobronchial tree become thicken and encroach on the diameter of the airway lumen. Increase mucus production in the peripheral airways. May be reversible in early states Defined as the presence of cough and sputum production for at least 3 month (Hargrove-Huttel, 2004)

Types of COPD cont. : 

Types of COPD cont. Emphysema Irreversible dilatation of the alveolus accompanied by destructive changes in the alveolar walls. - loss of recoil - bullae development (Hargrove-Huttel, 2004) Press the website below to see video

COPD – Pathophysiology : 

COPD – Pathophysiology Not completely understood Cigarette smoke main trigger Chronic inflammation of cells lining bronchial tree Leads to airway narrowing Edema Excess mucus production Decreased ciliary function (Huether & McCance, 2007)

COPD – Pathophysiology : 

COPD – Pathophysiology Hallmark of COPD Increased mucus production and reduced mucociliary clearance - cough and sputum production Loss of elastic recoil - airway collapse Increase smooth muscle tone Pulmonary hyperinflation Gas exchange abnormalities - hypoxemia and/or hypercapnia (The National Heart, Lung, and Blood Institute, 2009) Image retrieved from

COPD – Pathophysiology cont. : 

COPD – Pathophysiology cont. Top picture reveals a healthy aveolie The bottom picture shows damage to aveolie due to COPD (Mayo Foundation for Medical Education and Research, 2009) Image retrieved from

Key Indicators for COPD Diagnosis : 

Key Indicators for COPD Diagnosis

Physical signs : 

Physical signs Large barrel shaped chest (hyperinflation) Prominent accessory respiratory muscles in neck and use of accessory muscle in respiration Low, flat diaphragm Diminished breath sound. (Mayo Clinic, 2009) image retrieved from

Diagnosis of COPD : 

Diagnosis of COPD Image retrieved  from

Sign and Symptoms of COPD : 

Sign and Symptoms of COPD Decrease exercise tolerance Wheezing SOB, tachypnea, thin cough (smokers cough) Decreased FEV1 (evidence of airway production) test used is spirometry Copious amount of sputum Increase Paco2 (ABG) Marked hypoxemia = polycythemia and cynosis (McCance & Huether, 2006) Picture retrieved from Press below web site to see sound video

Diagnosis of COPD : 

Diagnosis of COPD Dx Best tool is pulmonary function testing (decrease spirometry) Physical examination History of symptoms ABG Hypoxia is main sign, increases with severity of disease. CXR R sided heart failure (Cor Pulmonal) BNP (helps more to dif from CHF) ECG or recent Echo with EF (McCance & Huether, 2006) Picture retrieved from

Classification of Chronic Obstructive Pulmonary Disease by Severity : 

Classification of Chronic Obstructive Pulmonary Disease by Severity


MANAGEMENTCOPD Management: 1) Smoking cessation 2) Chronic stable patients EVEN IN SEVERE CASES OF COPD THERAPY IS POSSIBLE AND CAN IMPROVE QOL (American Lung Association, 2009)

Chronic Stable COPDTreatment : 

Chronic Stable COPDTreatment Patient & Family education Pharmacotherapy Bronchodilators Steroids inhaled oral Oxygen Pulmonary Rehabilitation Surgery (McCance & Huether, 2006)


SMOKING CESSATION The only intervention shown to slow the progression of COPD Small improvements in FEV1 Eventually the rate of decline in lung function returns to the same level of a non-smoker Brief interventions are effective (American Lung Association, 2009)

Pharmacotherapy for Stable COPD : 

Pharmacotherapy for Stable COPD Bronchodilators Short-acting b2-agonist – Salbutamol Long-acting b2-agonist - Salmeterol and Formoterol Anticholinergics – Ipratropium, Tiiotropium Methylxanthines – Theophylline (McCance & Huether, 2006) Steroids Oral – Prednisolone Inhaled - Fluticasone, Budesonide

Pulmonary Rehabilitation : 

Pulmonary Rehabilitation Pts with COPD are often deconditioned Leads to muscle wasting – contributes to dyspnea Should encourage all pts to remain active Formal rehab programs improve QOL and dyspnea (The National Heart, Lung, and Blood Institute, 2009) play video below:

Don’t forget : 

Don’t forget Flu shot Pneumovax Vaccinations help prevent exacerbations!

End of life issues : 

End of life issues QOL of patients with COPD is often poor (especially end stage disease) Mortality during acute exacerbations 10-20% Discussions of end-of-life issues often occur late (and in the ICU) Recommend targeting patients with advanced disease & have survived ICU (The National Heart, Lung, and Blood Institute, 2009)


COPDSUMMARY COPD is preventable and treatable Most not diagnosed until late – prevention is paramount Spirometry is indicated for target groups Smoking cessation is the only intervention shown to slow disease progression

ConclusionWhat ever happen to the Marlboro man? : 

ConclusionWhat ever happen to the Marlboro man? Press website below to see video:

Summary Question : 

Summary Question 1) What is most common causes of Chronic obstructive pulmonary disease?

Answer : 

Answer Smoking

Question : 

Question 2) COPD is the number 1 cause of death in America? True False

Answer : 

Answer 2) False it is the fourth leading cause of death in U.S. A.

Question : 

Question 3) How would you expect Pao2 and Paco2 levels to show up in ABG analysis?

Answer : 

Answer 3) Airway obstruction results in decrease ventilation thus ABG will reveal low PaO2 and high PaCo2.

Question : 

Question 4) If a patient is hypoxia why is it a bad idea to give high amounts of oxygen?

Answer : 

Answer 4) Because of chronic elevation of Paco2, the central chemoreceptors no longer act as the primary stimulus for breathing. The role is taken over by the peripheral chemoreceptors which are sensetive to changes in Pao2.

Question : 

Question 5) What are the two main types of COPD?

Answer : 

Answer 5) Bronchitis and emphasema

Question : 

Question 5) What are the 5 key indicators of COPD?

Answer : 

Answer 6) Chronic coughChronic sputum production Dyspnoea Acute bronchitis History of exposure to risk factors

Question : 

Question 7) Chronic Obstructive Pulmonary Disease is classification of by severity which are?

Answer : 

Answer 7) 0= at risk for COPD I = Mild COPD II = Moderate COPD III = Severe COPD

Question : 

Question 8) Which is the only intervention shown to slow the progression of COPD and improve FEV1?

Answer : 

Answer 8) Smoking Cessation

Question : 

Question 9) What is the first line of therapy in treating COPD and how do it work?

Answer : 

Answer 9)All guidelines recommend inhaled bronchodilator as first line therapy because they work by reversing the increased bronchomotor tone, relaxing the smooth muscle, reduce the hyperinflation and improve breathlessness.

Question : 

Question 10) What vaccination are recommended in order to prevent exacerbation?

Answer : 

Answer 10) Flu shot Pneumovax

Reference : 

Reference American Lung Association. (2009). COPD fact sheet. Retrieved July 4, 2009, from American Thoracic Society (2009). Anatomy and Function of the Normal Lung. Retrieved July 5, 2009, from Freeky new. (2009). Cigarettes Pictures: Marlboro Statue of liberty . Retrieved July 5, 2009, from Get body smart: Respiratory system. (2009). Retrieved July 5, 2009, from Hargrove-Huttel, R.A. (2004). Lippincott's review series: Medical-surgical nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Kluwer, W. (2008). Nursing: Understanding disease. Ambler, PA: Lippincott Williams & Wilkins.

Reference : 

Reference Leader, D. (2009). Which Symptoms Led to Your COPD Diagnosis? Retrieved June 31, 2009, From Mayo Foundation for Medical Education and Research. (2009). COPD. Retrieved July 6,2009, from McCance, K. L., & Huether, S. E. (2006). Pathophysiology: The biologic basis for disease in adults and children (5th ed.). St. Louis, MO: Elsevier Health Science. McCance, K. L., & Huether, S. E. (2007). Understanding Pathophysiology. (4thed.). St. Louis, MO: Elsevier Health Science. Steady Health. (2008). Lung Diseases: Emphysema & tobacco smoke. Retrieved July 5, 2009, from The auscultation assistant. (2006). Breath sounds: Wheezes. Retrieved July 6, 2009, from

Reference : 

Reference The Marlboro man. (2007). Video posted to The National Heart, Lung, and Blood Institute. (2009). It Has a Name: COPD Chronic Obstructive Pulmonary Disease. Retrieved July 5, 2009, from Treating COPD . (2009, July 3). Video posted to Virtual Medical Centre. (2009). Emphysema. Retrieved July 3, 2009, from Wood, B. (2008). Pulmonary interstitial emphysema. Retrieved from

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